Luo Xuemei, Pietrobon Ricardo, Hey Lloyd
Center for Clinical Effectiveness, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Spine (Phila Pa 1976). 2004 Apr 15;29(8):884-90; discussion 891. doi: 10.1097/00007632-200404150-00012.
Secondary analysis of Medical Expenditure Panel Survey from 1996 to 1999.
To examine patterns in opioid use in 1996, 1997, 1998, and 1999 among individuals with back pain in the United States and to investigate trends in the use of overall and individual opioid category.
To the authors' best knowledge, no study has examined at a national level the patterns and trends in opioid use among individuals with back pain in the United States.
Individuals with back pain were stratified by sociodemographic characteristics and geographic regions. Rates of overall opioid use were compared among different strata by the use of simple and multivariate logistic regression models. To investigate trends in opioid use, use rates of the overall and individual opioid category in each year were calculated and compared.
From 1996 to 1999, wide variations in overall opioid use were consistently observed among individuals with different educational levels, family income, and health insurance status. Regional variation in opioid use was also observed for most of the 4 years. After adjustment for covariates, health insurance status and geographic regions were consistent predictors of opioid use from 1997 to 1999. Trend analysis indicated that the rates of overall opioid use increased slightly across the 4-year span. Among individual opioid categories, the use of oxycodone or hydrocodone increased, whereas the use of propoxyphene decreased.
The variation in overall opioid use among individuals with back pain with different sociodemographic characteristics and from different geographic regions suggested an opportunity to improve opioid prescribing patterns. The increase in the use of hydrocodone and oxycodone indicated a need to better assess the efficacy and safety associated with these drugs among individuals with back pain.
对1996年至1999年医疗支出小组调查进行二次分析。
研究1996年、1997年、1998年和1999年美国背痛患者的阿片类药物使用模式，并调查整体及各类阿片类药物的使用趋势。
据作者所知，尚无研究在国家层面调查美国背痛患者的阿片类药物使用模式和趋势。
根据社会人口统计学特征和地理区域对背痛患者进行分层。使用简单和多变量逻辑回归模型比较不同分层中的整体阿片类药物使用率。为了研究阿片类药物使用趋势，计算并比较每年整体及各类阿片类药物的使用率。
1996年至1999年期间，不同教育水平、家庭收入和医疗保险状况的患者在整体阿片类药物使用上始终存在广泛差异。在这4年中的大部分时间里，阿片类药物使用的区域差异也很明显。在对协变量进行调整后，医疗保险状况和地理区域是1997年至1999年阿片类药物使用的一致预测因素。趋势分析表明，在这4年期间，整体阿片类药物使用率略有上升。在各类阿片类药物中，羟考酮或氢可酮的使用增加，而丙氧芬的使用减少。
不同社会人口统计学特征和不同地理区域的背痛患者在整体阿片类药物使用上的差异表明有机会改善阿片类药物的处方模式。氢可酮和羟考酮使用的增加表明需要更好地评估这些药物在背痛患者中的疗效和安全性。
